Basic Information
| Provider Information | |||||||||
| NPI: | 1265807614 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STERLING MEDICAL LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 740 S WOODRUFF AVE | ||||||||
| Address2: | |||||||||
| City: | IDAHO FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 834015285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085429111 | ||||||||
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| Practice Location | |||||||||
| Address1: | 630 E 1400 N STE 150 | ||||||||
| Address2: | |||||||||
| City: | LOGAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 843412534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4359154465 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2015 | ||||||||
| LastUpdateDate: | 12/10/2015 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2087057747 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.